Recommendation 3 - Improve the level of compassionate, professional, clinically competent patient care through enhanced training and education, performance evaluation, quality assurance, and employee qualifications and discipline.

Title: Recommendation 3a
Action Item:
The Medical Director shall implement, no later than December 31, 2008, a comprehensive training and educational program for emergency medical technicians and paramedics. The program shall include new employee orientation, periodic classroom and internet-based continuing training, case review and peer learning opportunities, simulation exercises and field-based training. The Department shall pursue partnerships with medical education institutions to enhance training and clinical practice and increase the internal training capacity of the Department. The training program may include Department and external trainers under contract, as deemed appropriate by the Medical Director.

• Progress:

Implementation of this recommendation has been ongoing since 2008. For more information about recent EMS training improvements, please read the reports available here: [See Link] 
Status: Complete

Title: Recommendation 3b
Action Item:
The Medical Director shall establish, no later than November 20, 2007, procedures to certify the operational competency of medical providers at all levels of training within the Department. This may include, but is not limited to, (i) demonstration of compassionate and professional service to patients; (ii) successful execution of key clinical competencies in the field; and (iii) completion of a minimum number of hours or medical calls under provisional status.

• Progress: 

Implementation of this recommendation is ongoing.  In 2016, EMS supervisors began conducting regular clinical evaluations of the Department’s ALS providers.  In 2018, the Department launched a new Field Training Officer program for new ALS providers, and the Office of the Medical Director began tracking ALS interventions by ALS providers.  
Status: Complete

Title: Recommendation 3c
Action Item:
The Medical Director shall establish, no later than November 20, 2007, a process to evaluate current employees for proficiency at their respective levels of clinical privileges. This evaluation and certification process shall be completed not later than December 31, 2008. Effective December 31, 2008, response to medical calls may be provided only by Department apparatus with at least one field-certified provider as described above.

• Progress:

On November 16, 2007, the Department established a new annual field evaluation process for all EMS providers. The first complete cycle of annual field evaluation for the Operations Division (1,776 personnel) was completed on March 10, 2009. 1,624 personnel demonstrated satisfactory levels of proficiency at their respective levels of clinical privileges. 152 personnel assigned to the Operations Division were unavailable to be evaluated due to extended sick leave status, military leave, detail to other divisions, or other reasons. Personnel unavailable to be evaluated were scheduled for field evaluations upon their return to full-duty status in the Operations Division.
In 2016, EMS supervisors began conducting regular clinical evaluations of the Department’s ALS providers.  In 2018, the Department launched a new Field Training Officer program for new ALS providers, and the Office of the Medical Director began tracking ALS interventions by ALS providers.  
The Department is compliant with the directive that response to medical calls must be provided by apparatus with at least one field-certified provider as described above. 
Status: Complete

Title: Recommendation 3d (Part 1)
Action Item:
Effective immediately, the Medical Director shall oversee the clinical performance evaluation of all personnel with medical certification at least once a year.
In addition to any other disciplinary basis (see sub-recommendation (k) below), based on the results of the annual performance evaluation, personnel may be approved for continued duty, assigned to supplemental training, placed on provisional EMS status, or temporarily or permanently relieved of their EMS proficiency status.

• Progress:

Implementation of this recommendation is ongoing.  In 2016, EMS supervisors began conducting regular clinical evaluations of the Department’s ALS providers.  In 2018, the Department launched a new Field Training Officer program for new ALS providers, and the Office of the Medical Director began tracking ALS interventions by ALS providers.  
Status: Complete

Title: Recommendation 3d (Part 2)
Action Item:
The Department shall also provide enhanced field supervision as ongoing quality assurance for all personnel.

• Progress:

(Note, this recommendation is supported by recommendation 2c.)
Responsibility for enhanced role in quality assurance has been given to EMS Field Supervisors.
Status: Complete

Title: Recommendation 3e (Part 1)
Action Item:
The Medical Director shall establish, no later than December 31, 2007, a clearly documented chain of patient care with clear evaluation and treatment documented by each provider as follows: The first arriving provider (Fire-based or EMS) should document the situation as well as patient evaluation and treatment; A formal process for "giving report" and transferring care to the next provider should be conducted; this process should be repeated as patient care is transferred until full transfer to emergency department staff or other appropriate final patient destination staff; Documentation requirements should include: (1) all evaluation and treatment, (2) all providers, (3) all care transfers, and (4) documentation of  arrival at the receiving facility as well as who and when the transfer to receiving facility personnel occurred;

• Progress:

Clearly documented chain of patient care was accomplished in September 2006 with full implementation of the FEMS Form 902EMS* (First Responder Report).
All assessment and patient care currently is documented on the Department’s Electronic Health record (ePCR). All units dispatched to a call are required to document their participation on the scene. First Responders may forward their ePCR to the transporting unit. All reports are archived by incident number and are available for review. The ePCR is currently compliant with established NEMSIS guidelines.
Status: Complete

Title: Recommendation 3e (Part 2)
Action Item:
Online medical direction to FEMS personnel shall be provided only by licensed physicians who are adequately trained and are designated as qualified by the Medical Director. Online medical direction shall be subject to the QI process.

• Progress:

The Department, in collaboration with the directors of the local emergency departments, has re-engineered the online medical control process such that each receiving facility is now responsible for providing medical control to patients en-route to its facility. Protocol revisions allow for most emergency care to be delivered with standing orders.
Status: Complete

Title: Recommendation 3f 
Action Item: 
The Chief, no later than December 31, 2007, shall design and implement an annual program to recognize and publicly reward employees for EMS performance that demonstrates exceptional compassion, professionalism, and clinical competence. 

• Progress

On May 23, 2007, DC Fire & EMS combined the annual EMS awards ceremony to demonstrate its value. DC Fire & EMS continued to improve and increase the emphasis placed on EMS during the annual awards ceremony. Department-wide awards ceremonies that include recognition of EMS care have been held regularly ever since.
Status: Complete

Title: Recommendation 3g
Action Item:
The Chief shall periodically conduct confidential, anonymous surveys of Department employees (both single-role and dual-role) regarding their attitudes, concerns, and opinions relating to the Department's provision of emergency medical services. The first survey shall be completed no later than December 31, 2007.

• Progress:

The first confidential employee survey was distributed by the Office of the City Administrator to all 1,787 operational FEMS employees. The overall participation rate was just under 44%, with 781 invitees responding. The results were used both to inform follow-up questions and as a baseline for further periodic surveys of the workforce. The survey was repeated in 2015 and 2017.
Status: Complete

Title: Recommendation 3h (Part 1)
Action Item:
The Medical Director shall, no later than December 31, 2008, take the following steps to develop a performance evaluation and quality control/quality assurance: establish a FEMS peer review program that promotes a culture of excellence;

• Progress:

Peer review enabling legislation became effective on 4/15/08. The Department currently utilizes peer-review on an ad-hoc basis, and is establishing a structured peer-review program as a component of its overall medical quality management efforts.
Status: Complete

Title: Recommendation 3h (Part 2)
Action Item:
The Medical Director shall, no later than December 31, 2008, work with other jurisdictions and the federal government to regionalize system management.

• Progress:

The District submitted a grant proposal to improve integration of the National Capital Region’s (NCR) pre-hospital information systems. This proposal was endorsed by the Homeland Security Senior Policy Group and Chief Administrative Officers of the NCR and is being funded through the federal Urban Area Security Initiative (UASI) program. This initiative will support the integration of the existing systems and the identification of needs for new systems where such do not already exist. DCFEMS has participated in numerous UASI Grants for EMS Equipment and Training as well as participated in regional Trauma Care Committees.
Status: Complete

Title: Recommendation 3h (Part 3)
Action Item:
The Medical Director shall, no later than December 31, 2008, issue customer satisfaction surveys, internal and external, that focus on EMS service.

• Progress:

An EMS-focused customer survey is now mailed to all identifiable patients transported and/or treated by DC Fire & EMS. The Department also provides the ability for the public to report customer satisfaction through its agency website.  Data from the survey is available on the Department’s Performance website [See Link Here].
Status: Complete

Title: Recommendation 3h (Part 4)
Action Item:
The Medical Director shall, no later than December 31, 2008, improve response time evaluation that has a goal of measuring time to patient's side.

• Progress:

The Department is utilizing multiple data streams and has very detailed metrics for response time, committed time, and patient drop time.  Such information is being used to enhance performance.
Status: Complete

Title: Recommendation 3h (Part 5)
Action Item:
The Medical Director shall, no later than December 31, 2008, measure and analyze patient outcome.

• Progress:

The Department measures and publishes data on patient care and patient outcomes on its Performance website [See Link Here].
Status: Complete

Title: Recommendation 3h (Part 6)
Action Item: 
The Medical Director shall, no later than December 31, 2008, improve complaint tracking by FEMS.

• Progress: Investigation protocol and complaint tracking system have been developed.

Status: Complete

Title: Recommendation 3i (Part 1)
Action Item: 
The Chief shall, no later than December 31, 2007, establish hiring preferences for candidates with degrees from recognized accredited higher education institutions and relevant certifications or skills.

• Progress: 

FEMS has established hiring preferences and a process for hiring that takes Education, Certification and Skills into consideration for certain administrative positions.  Firefighter EMT candidates are not required to have higher education degrees.  Firefighter Paramedic candidates are required to have graduated from a paramedic training program.
Status: Complete

Title: Recommendation 3i (Part 2)
Action Item: 
The Chief shall, no later than December 31, 2007, subject to collective bargaining agreements, establish promotional preferences for employees with degrees from recognized accredited higher education institutions and relevant certifications or skills.

• Progress:  

The Department gives points for education to candidates for promotion, pursuant to the collective bargaining agreement with Local 36 of the International Association of Fire Fighters. 
Status: Complete

• Progress:     

• Progress:   

Title: Recommendation 3k (Part 1)
Action Item: 
The Chief shall, no later than December 31, 2008, establish an Internal Affairs Unit. 

• Progress:

Title: Recommendation 3k (Part 2)
Action Item: 
The Chief shall, no later than December 31, 2008, establish a table of penalties and disciplinary timelines for operational employees. Penalties for employee misconduct should be swift, fair and appropriate.

• Progress:   

Title: Recommendation 3k (Part 3)
Action Item: 
The Chief shall, no later than December 31, 2008, establish online records and tracking for Quality Assurance/Quality Control.

• Progress:   

The Department has moved its EMS complaint tracking database online and also provides the ability for the public to report concerns and complaints online through its agency website.
Status: Complete

Title: Recommendation 3l
Action Item: 
The District Attorney General, in consultation with the Chief of the Department, shall submit to the Chair of the DC Council Committee on Public Safety and the Judiciary, no later than November 20, 2007, recommendations to strengthen the Department's ability to terminate Department employees for medical malfeasance and misconduct.

• Progress:

Title: Recommendation 3m
Action Item: 
The FEMS Chief, Dr. Barbera and Mr. Halliday shall complete a plan to monitor implementation and performance measures relating to the recommendations of the Task Force that includes input, process and output metrics. Progress on implementation and performance shall be monitored through ongoing CapStat sessions to which all members of the Task Force shall be invited, including sessions in April and October of 2008 that will specifically address the implementation and performance monitoring plan.

• Progress: